In some patients with bleeding or uncomfortable internal hemorrhoids, operation is not necessary; the excess hemorrhoidal tissue can be removed by a simple office procedure called hemorroidal banding.

This procedure can be done in the office because the hemorrhoidal tissue which is inside the rectum is not sensitive (unlike external hemorrhoids, which are quite sensitive). It involves placing a short anoscope (viewing tube) into the anus, and applying a small rubber band around the hemorrhoid. This causes the excess tissue to die and to fall off after one or two weeks. If there are many hemorrhoids, one or two more treatments may be needed.

No special preparation is necessary before the procedure.

During the procedure, you will be lying either face down bent at the waist, or on your left side. The scope will be placed into your anus, which shouldn't be too uncomfortable. The doctor will then pinch the internal hemorrhoids with an instrument to make sure that it doesn't hurt, and will then place one to three rubber bands on the hemorrhoids. This will cause some pressure-like discomfort, but it shouldn't cause any pain; if it does, the rubber band can be removed.

After the banding, there are no restrictions. The minor discomfort will improve in a few days. You should be careful to avoid constipation. There may be some bleeding with bowel movements, especially in one or two weeks when the tissue falls off; there shouldn't be more than a few drips of blood. If there is more bleeding than this, lie down and put your feet up for two hours. If more bleeding occurs, call the doctor.

Banding does permanently remove some hemorrhoidal tissue. However, hemorrhoids may recur, and repeat treatment or operation may be necessary in the future. Avoiding constipation and straining on the toilet will help prevent recurrence.

There are three risks of hemorrhoidal banding. One is that it may not work perfectly, and that repeat banding or operation may be necessary. Second, bleeding can occur when the tissue falls off. If this is severe, it may be necessary to put a stitch in the area; this is very rare. Third, the area can sometimes become infected as the tissue dies. This can be a very serious problem, and people have died from it, although it is very rare. Infection causes severe pain in the anal area. If there is any pain (more than the pressure-like discomfort) or fever, you should call the doctor immediately.